Pahwa Rajesh, Lyons Kelly E, Wilkinson Steven B, Simpson Richard K, Ondo William G, Tarsy Daniel, Norregaard Thorkild, Hubble Jean P, Smith Donald A, Hauser Robert A, Jankovic Joseph
Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
J Neurosurg. 2006 Apr;104(4):506-12. doi: 10.3171/jns.2006.104.4.506.
The effects of thalamic deep brain stimulation (DBS) on essential tremor (ET) and Parkinson disease (PD) have been well documented, but there is a paucity of long-term data. The aim of this study was to evaluate the long-term safety and efficacy of DBS of the ventralis intermedius nucleus (VIM) of the thalamus for PD and ET.
Thirty-eight of 45 patients enrolled at five sites completed a 5-year follow-up study. There were 26 patients with ET and 19 with PD undergoing 29 unilateral (18 ET/11 PD) and 16 bilateral (eight ET/eight PD) procedures. Patients with ET were evaluated using the Tremor Rating Scale, and patients with PD were evaluated using the Unified Parkinson's Disease Rating Scale. The mean age of patients with ET was 70.2 years and 66.3 years in patients with PD. Unilaterally implanted patients with ET had a 75% improvement of the targeted hand tremor; those with bilateral implants had a 65% improvement in the left hand and 86% in the right compared with baseline. Parkinsonian patients with unilateral implants had an 85% improvement in the targeted hand tremor and those with bilateral implants had a 100% improvement in the left hand and 90% improvement in the right. Common DBS-related adverse events in patients receiving unilateral implants were paresthesia (45%) and pain (41%), and in patients receiving implants bilaterally dysarthria (75%) and balance difficulties (56%) occurred. Device-related surgical revisions other than IPG replacements occurred in 12 (27%) of the 45 patients.
Thalamic stimulation is safe and effective for the long-term management of essential and Parkinsonian tremors. Bilateral stimulation can cause dysarthria and incoordination and should be used cautiously.
丘脑深部脑刺激（DBS）对特发性震颤（ET）和帕金森病（PD）的影响已有充分记录，但长期数据匮乏。本研究的目的是评估丘脑腹中间核（VIM）DBS治疗PD和ET的长期安全性和有效性。
在五个地点入组的45例患者中有38例完成了一项5年的随访研究。其中26例ET患者和19例PD患者接受了29例单侧（18例ET/11例PD）和16例双侧（8例ET/8例PD）手术。ET患者使用震颤评定量表进行评估，PD患者使用统一帕金森病评定量表进行评估。ET患者的平均年龄为70.2岁，PD患者为66.3岁。单侧植入的ET患者目标手震颤改善了75%；双侧植入的患者左手改善了65%，右手改善了86%，与基线相比。单侧植入的帕金森病患者目标手震颤改善了85%，双侧植入的患者左手改善了100%，右手改善了90%。接受单侧植入的患者常见的与DBS相关的不良事件是感觉异常（45%）和疼痛（41%），接受双侧植入的患者出现构音障碍（75%）和平衡困难（56%）。45例患者中有12例（27%）进行了除植入式脉冲发生器（IPG）更换以外的与设备相关的手术翻修。
丘脑刺激对特发性和帕金森氏震颤的长期管理是安全有效的。双侧刺激可导致构音障碍和不协调，应谨慎使用。
